Keyanna, a woman living in north Florida, knows all about the fallout from Florida’s well-intentioned but short-sighted crackdown on opioids. New state laws and regulations that govern opioid prescriptions have brought heavy handed scrutiny from law enforcement agencies on Florida physicians, pharmacists and pain patients.
Like many people who suffer from chronic pain, Keyanna has a frightening list of diagnoses: two failed back surgeries, arachnoiditis, reflex sympathetic dystrophy, Hepatitis B, chronic obstructive pulmonary disease, arthritis, stage 4 endometriosis, myofacial pain, fibromyalgia and chronic fatigue. Who could doubt the harrowing pain Keyanna lives with minute-by-minute, every day of her life?
Keyanna lives in a rural county where medical care and pharmacies are in short supply. On May 9, she received only a part of her prescription for methadone and was told by her pharmacist to return the following week, when he would fill the remainder of her prescriptions. But when Keyanna arrived days later, the pharmacist told her — with no explanation — that he would no longer fill her prescriptions and she’d have to go elsewhere. He didn’t give Keyanna a referral; he simply abandoned her to pain and possible withdrawal symptoms if she didn’t find another pharmacist.
After numerous failed attempts to locate a willing pharmacist, Keyanna sank into withdrawal from methadone. This doesn’t mean she was addicted, it simply means that Keyanna couldn’t abruptly stop her medication. She needed to come off the medicine slowly under a physician’s supervision.
Keyanna’s sister contacted a pharmacist a hundred miles away, who agreed to fill Keyanna’s outstanding prescriptions. But after driving for two hours, the sister was turned away by the pharmacist, saying that he couldn’t fill a prescription for methadone for a patient living more than ten miles from the pharmacy.
As of this writing, Keyanna and her family have failed in all efforts to locate a sympathetic pharmacist – or, in my estimation, a compassionate ethical pharmacist willing to care for a desperately sick patient.
Keyanna lives in a state that is the poster child for prescription drug abuse. Florida pill mills saw patients from all over the southeastern United States who were ostensibly seeking relief from pain. In reality, many of these medicine “seekers” were opioid addicts and pushers who illegally obtained prescriptions to resell to non-patients. These pill mills fanned the fires of drug diversion, addiction and death.
Florida’s legislature and governor enacted laws to combat these problems. But the new regulations have had unintended consequences that go far beyond the needed shuttering of pill mills. Among the many problems pain patients now face in Florida, one of the most frightening is the increased discretion that pharmacists have in filling opioid analgesic prescriptions for legitimate pain patients like Keyanna.
Donna Ratliff is a tireless pain care activist in Lithia, a suburb of Tampa. Several months ago she started a private Facebook page called “The Pharmacy Crawl” that is dedicated to changing opioid prescription laws so that they accommodate legitimate pain patients. Members of her group also help each other find pharmacists willing to fill their lawful prescriptions. Keyanna, who asked that her last name not be used, is a member of the “The Pharmacy Crawl.”
Ms. Ratliff, who suffers from constant pain, says Florida’s crackdown on pill mills has instilled fear in pharmacists up and down the state. Several pharmacies have been temporarily shuttered by overzealous regulators. Many pharmacists are worried they could lose their licenses if they fill too many prescriptions for opioid medicines or fill prescriptions that call for high doses of the analgesics.
So they turn people like Keyanna away.
How could anyone in the healing arts allow this situation to continue? How could a pharmacist turn away a patient he knows will be, or already is, in withdrawal? Withdrawal is no picnic. There is increased pain, profuse sweating, nausea, diarrhea, vomiting, chills, sleep and mood disturbances.
What prevents one of these pharmacists that Keyanna contacted from picking up the phone and discussing her case with Keyanna’s physician? Why couldn’t one of them check Keyanna out on that state’s Patient Monitoring Program that lists patients with valid prescriptions for opioid medicines? Minimal questioning would determine that Keyanna is a legitimate patient.
These are small inconveniences when compared to the suffering of Keyanna and the thousands like her suffering in pain, despair and silence.
This atmosphere of fear and suspicion in Florida and other states about opioid use is in all likelihood increasing the numbers of suicides among patients who can’t find appropriate care. We know that depression and suicidal thoughts are higher among pain patients than in the general population.
We need to do all we can to stop diversion and misuse of these powerful analgesics. But our efforts need to be grounded in good research that generates valid and reliable evidence. We also need to be fair and protect access to these lifesaving analgesics for legitimate pain patients.
The medical community in Florida needs to end Keyanna’s suffering now.
Mark Maginn lives in the east bay of San Francisco where he is a poet, writer and social justice activist. Mark suffers from chronic pain and was a longtime volunteer with the American Pain Foundation. His blog can be found here.
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